National Cancer Institute®
Last Modified: November 21, 2001
UI - 21440184
AU - Kochakarn W; Chaimuangraj S; Leenanupunth C; Muangman V
TI - Risk factors of urethral involvement of bladder cancer after radical cystectomy with orthotopic neobladder in females.
SO - J Med Assoc Thai 2001 Jun;84(6):889-92
AD - Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
The cystectomy and urethrectomy specimens of 20 females with invasive bladder cancer were studied for evidence of urethral involvement. The bladder showed transitional cell carcinoma in 18 cases (90%) and squamous cell carcinoma in 2 cases (10%). Urethral involvement was found in 5 cases (25%). The trigone was the most common site of tumor (50%) which had 33 per cent chance of urethral involvement. Bladder neck was the next common site of tumor (15%) and had 66 per cent chance of urethral involvement. High stage (T3b, T4) and high grade (III) at trigone also correlated with urethral involvement. The tumor bearing node showed only 20 per cent correlation with urethral involvement. Female patients with high stage/high grade at trigone and any stage/grade at bladder neck are at high risk of urethral recurrence after radical cystectomy and orthotopic neobladder procedure.
UI - 21268708
AU - Cohen EE; Stadler WM
TI - Treatment of metastatic urothelial cancer in the post-MVAC era.
SO - World J Urol 2001 Apr;19(2):126-32
AD - Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois, USA.
The combination of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) has become the standard of care for metastatic urothelial cancer. Its efficacy has been proven in this setting but it can be a difficult regimen to tolerate. With the introduction of new active agents, different combinations are being evaluated. This article will highlight the use of these new regimens with emphasis on those employing gemcitabine or the taxanes.
UI - 21268709
AU - Lehmann J; Retz M; Stockle M
TI - The role of adjuvant chemotherapy for locally advanced bladder cancer.
SO - World J Urol 2001 Apr;19(2):133-40
AD - Department of Urology, University Saarland, 66421 Homburg/Saar, Germany. email@example.com
The incidence of locally advanced bladder cancer is estimated at 5 new cases per 100,000 of the population annually in North America and most European countries. Radical cystectomy for muscle-invasive organ-confined tumors and locally advanced disease, which is defined as extravesical tumor growth or involvement of regional lymph nodes, is the preferred treatment in Japan, the United States, and in some countries of Europe. The clinical outcome of radical cystectomy has improved remarkably over the past 20 years as a result of advances in operative technique and perioperative care. Nevertheless, at least 50% of patients with invasive bladder cancer are expected to develop progressive disease within the first 2 years when treated with radical cystectomy alone. In order to improve the fate of muscle-invasive and locally advanced disease, the administration of additional therapy to definite treatment has been studied in various forms, such as neoadjuvant and adjuvant systemic chemotherapy as well as combined radio-chemotherapy. Prolonged progression-free survival for patients suffering from locally advanced bladder cancer by administration of adjuvant systemic chemotherapy has been suggested by three randomized studies, published by Skinner, Freiha and Stockle since 1991. These studies demonstrated a disease-free survival benefit of 17-50% within the first 3-5 years when applying adjuvant systemic chemotherapy after radical cystectomy. Patients who most likely benefit from adjuvant chemotherapy are those with limited node-positive disease, extravesical tumor, and direct invasion into adjacent viscera, such as prostate, uterus, or vagina. This review will summarize past, current, and future aspects of systemic adjuvant chemotherapy for transitional cell carcinoma of the bladder.
UI - 21268704
AU - Sternberg CN; Calabro F
TI - Neo-adjuvant chemotherapy in invasive bladder cancer.
SO - World J Urol 2001 Apr;19(2):94-8
AD - Vincenzo Pansadoro Foundation, Via Aurelia 559, Rome, 00165 Italy. firstname.lastname@example.org
In patients with locally advanced muscle-invasive bladder cancer, neo-adjuvant chemotherapy was designed to treat micrometastatic disease present in up to 50% of patients at the time of diagnosis. Early chemotherapy has been combined with local therapy based on the reasoning that treatment of small volume disease would result in a better outcome. Another reason for giving neo-adjuvant chemotherapy is in an attempt to save the bladder. In selected patients, bladder preservation can be achieved with the use of chemotherapy plus radiotherapy, partial cystectomy, or transurethral resection of the bladder (TURB). Neo-adjuvant chemotherapy and bladder preservation remain controversial topics, as radical cystectomy is still considered to be the gold standard of treatment for muscle-invasive bladder cancer. The true success of bladder-preserving treatment by chemotherapy with or without RT will require validation in prospective randomized trials.
UI - 21384900
AU - Oosterlinck W
TI - Recent clinical trials in superficial bladder cancer.
SO - Curr Opin Urol 2001 Sep;11(5):511-5
AD - Department of Urology, University Hospital Ghent, Ghent, Belgium. email@example.com
The present review addresses literature regarding the management of definitive winner among urinary markers of bladder cancer, because they lack specificity or are insufficiently tested. Pathologists continue in their efforts to improve prediction of evolution of superficial bladder cancer to recurrent or infiltrative disease. A few studies have confirmed the value of previously described prognostic factors for recurrence and progression, and have added some refinements. Transurethral resection is not as complete as was believed. Fluorescence detection of flat bladder carcinoma has been demonstrated to improve diagnosis and treatment. The necessity to perform a repeat transurethral resection in high-grade superficial bladder cancer became evident. Identification of the working mechanisms of bacille Calmette-Guerin on superficial bladder cancer remains an important objective, and may help to improve treatment schedules and avoid the morbidity associated with bacille Calmette-Guerin administration. Patients who are at high risk may benefit from long-term maintenance bacille Calmette-Guerin therapy. Valrubicin and keyhole limpet haemocyanin appear to be promising agents in the treatment of superficial bladder cancer.
UI - 21384901
AU - Bellmunt J; Albiol S
TI - New chemotherapy combinations for advanced bladder cancer.
SO - Curr Opin Urol 2001 Sep;11(5):517-22
AD - Medical Oncology Service, General University Vall d'Hebron Hospital, Barcelona, Spain. firstname.lastname@example.org
Transitional cell carcinoma of the urothelium is considered a chemosensitive malignancy. Until recently, the methotrexate, vinblastine, doxorubicin and cisplatin combination has been considered the standard for treating this disease. The development of new chemotherapeutic agents such as gemcitabine and the taxanes has opened up promising new perspectives in the treatment of this disease. However, the preliminary phase II data must be confirmed in adequately conducted phase III trials.
UI - 21384902
AU - Sternberg CN
TI - Second-line treatment of advanced transitional cell carcinoma of the urothelial tract.
SO - Curr Opin Urol 2001 Sep;11(5):523-9
AD - Vincenzo Pansadoro Foundation, Clinic Pio XI, Rome, Italy. email@example.com
Cisplatin-based combination chemotherapy such as methotrexate, vinblastine, adriamycin and cisplatin produces durable improvements in survival in only a minority of patients. Therefore, other therapeutic options and strategies are clearly needed. Strategies include increasing the dose of chemotherapy, modifying the sequencing of chemotherapy, and new therapeutic agents. This paper reviews recent work on high-dose chemotherapy, currently available chemotherapeutic agents and combinations, with an emphasis on gemcitabine and the taxanes. New strategies such as monoclonal antibody therapy and molecular targeted small molecule therapy are becoming a reality in the treatment of many diseases. The rationale for using epidermal growth factor receptor targeted therapies is also reviewed.
UI - 21356595
AU - Game X; Soulie M; Seguin P; Vazzoler N; Tollon C; Pontonnier F; Plante P
TI - Radical cystectomy in patients older than 75 years: assessment of morbidity and mortality.
SO - Eur Urol 2001 May;39(5):525-9
AD - Department of Urology and Andrology, Rangueil University Hospital, Toulouse, France.
OBJECTIVE: We have reviewed our surgical experience to assess intra- and postoperative morbidity and mortality in 25 patients 75 years old or older with invasive bladder cancer who underwent radical cystectomy and men and 2 women were aged from 75 to 87 (median 79) years. Urinary diversion was performed in 23 cases and bladder substitution in 2. All patients had significant comorbidity and 15 patients were ASA II and 10 ASA III. RESULTS: Median operating time was 4 h. Perioperative mortality rate was 4%. Intraoperative, early and late postoperative complications occurred in 15, 16 and 6 patients, respectively. The most common early complications were pyelonephritis (32%), disorientation (20%), additional pulmonary infection (20%) and prolonged ileus (32%). No secondary procedures were necessary. The most common late complication was ureteroileal anastomotic stricture (16%). The median hospital stay and intensive care unit stay were 24 and 14 days, respectively. With a median follow-up of 14 (5-50) months the overall mortality rate was 32%. CONCLUSIONS: Radical cystectomy can be performed in elderly patients with acceptable perioperative mortality and morbidity. However, because of the high incidence of minor medical complications, hospital stay is often prolonged.
UI - 21444663
AU - Paroni R; Salonia A; Lev A; Da Pozzo LF; Cighetti G; Montorsi F; Rigatti
TI - P; Colombo R Effect of local hyperthermia of the bladder on mitomycin C pharmacokinetics during intravesical chemotherapy for the treatment of superficial transitional cell carcinoma.
SO - Br J Clin Pharmacol 2001 Sep;52(3):273-8
AD - Department of Laboratory Medicine, IRCCS H San Raffaele, via Olgettina 60,20132 Milan, Italy. firstname.lastname@example.org
AIMS: To assess the effect of local hyperthermia on the systemic absorption of mitomycin C (MMC) during intravesical chemotherapy for the treatment of superficial transitional cell carcinoma of the bladder, and to establish the likely safety of this procedure. METHODS: Group 1 (n = 12) received 20 mg intravesical MMC plus local hyperthermia, group 2 (n = 13) 20 mg MMC alone, group 3 (n = 16) 40 mg MMC plus local hyperthermia and group 4 (n = 10) 40 mg MMC alone. Patients in groups 1, 2, and 4 underwent post-tumour resection adjuvant treatment, whereas those in group 3 still had tumour present and were treated to eradicate it. Intravesical instillation lasted 60 min, with the solution (50 ml) being replaced after the first 30 min. Blood samples were taken before, and every 15 min during instillation. MMC concentrations in plasma and in urine were determined by h.p.l.c. RESULTS: The highest MMC plasma concentration (67.9 ng ml(-1)) occurred in a patient in group 3. This value was well below the threshold concentration (400 ng ml-1) for myelosuppression. Local hyperthermia associated with the intravesical chemotherapy enhanced plasma MMC concentrations at 30, 45 and 60 min compared with chemotherapy alone (Group 1 vs 2, P < or = 0.008). Systemic exposure to MMC was not significantly increased by doubling the intravesical dose when intravesical chemotherapy alone was administered. Patients in group 3 displayed the highest degree of MMC absorption and the greatest variability in pharmacokinetics between patients. CONCLUSIONS: Local hyperthermia enhances the systemic absorption of MMC during intravesical chemotherapy for bladder cancer. In the doses used, plasma MMC concentrations were always more than six times lower than those shown to cause toxicity.
UI - 21448058
AU - Bonfil RD; Gonzalez AD; Siguelboim D; Cuello Carrion FD; Ciocca DR;
TI - Villaronga A; Metz L; Mosso F; Fayad E; Reale M; Schmilovich AJ Immunohistochemical analysis of Ki-67, p21waf1/cip1 and apoptosis in marker lesions from patients with superficial bladder tumours treated with vinorelbine intravesical therapy in a preliminary phase I trial.
SO - BJU Int 2001 Sep;88(4):425-31
AD - Laboratory of Fundacion de Investigacion del Cancer at CEFYBO, Buenos Aires, Argentina. email@example.com
OBJECTIVE: To investigate Ki-67 and p21Waf1/Cip1 expression and apoptosis, before and after treatment, in tumour biopsies obtained from patients with superficial bladder cancer who underwent vinorelbine intravesical therapy. PATIENTS AND METHODS: Twenty patients with high-risk superficial bladder cancer (including one or more of the following parameters: tumour diameter > 3 cm, histological grade 3, or multicentric tumours) were treated 1-6 times (weekly) with intravesical vinorelbine (50 mg/mL) instillations. Transurethral tumour marker biopsies were obtained one week before the first instillation of the drug and one week after the last. The biopsies were immunostained for Ki-67 and p21Waf1/Cip1 with monoclonal antibodies, on tissue sections derived from paraffin-embedded samples obtained before and after vinorelbine treatments. In addition, apoptosis was determined using a terminal deoxynucleotidyl transferase-mediated dUTP biotin nick-end labelling (TUNEL) technique. RESULTS: There were no significant differences in the cell proliferation marker Ki-67 in biopsies taken before or after treatment. However, p21Waf1/Cip1 showed significantly higher expression in biopsies obtained after vinorelbine treatment, with median (range) values of 40 (20-90)% before and 70 (50-80)% after (P < 0.001, paired nonparametric Wilcoxon test). The apoptotic index was significantly higher after vinorelbine therapy, with median (range) values of 0.89 (0.06-3.8)% before and 2.25 (0.17-18.7)% after treatment (P < 0.001, paired nonparametric Wilcoxon test). Despite the brief treatment and few patients there was a clinical response in nine patients, together with low toxicity in all. CONCLUSION: The intravesical treatment of tumours with vinorelbine affects p21Waf1/Cip1 expression without blocking cell proliferation, although increasing apoptosis. The preliminary results suggest that vinorelbine may be useful for treating superficial bladder tumours, and thus a phase II study is warranted.
UI - 21448060
AU - Dryhurst DJ; Fowler CG
TI - Flexible cystodiathermy can be rendered painless by using 2% lignocaine solution to provide intravesical anaesthesia.
SO - BJU Int 2001 Sep;88(4):437-8
AD - Academic Urological Unit, The Royal London Hospital, London, UK. firstname.lastname@example.org
UI - 21445101
AU - Bajorin DF
TI - Plenary debate of randomized phase III trial of neoadjuvant MVAC plus cystectomy versus cystectomy alone in patients with locally advanced bladder cancer.
SO - J Clin Oncol 2001 Sep 15;19(18 Suppl):17S-20S
AD - Genitourinary and Head and Neck Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
UI - 21445102
AU - Sternberg CN; Parmar MK
TI - Neoadjuvant chemotherapy is not (yet) standard treatment for muscle-invasive bladder cancer.
SO - J Clin Oncol 2001 Sep 15;19(18 Suppl):21S-26S
AD - Vincenzo Pansadoro Foundation, Rome, Italy. email@example.com
UI - 21458882
AU - Hara S; Miyake H; Fujisawa M; Okada H; Arakawa S; Kamidono S; Hara I
TI - Prognostic variables in patients who have undergone radical cystectomy for transitional cell carcinoma of the bladder.
SO - Jpn J Clin Oncol 2001 Aug;31(8):399-402
AD - Department of Urology, Kobe University School of Medicine, Kobe, Japan.
OBJECTIVE: To evaluate whether several clinicopathological factors could be used as prognostic predictors in patients who have undergone radical cystectomy for transitional cell carcinoma (TCC) of the bladder. radical cystectomy and pelvic lymphadenectomy for TCC of the bladder at a single institution. Their clinicopathological findings were analyzed based on the criteria of the Japanese Urological Association. RESULTS: Histopathological examination revealed that the tumor grade was 1 or 2 in 22 patients and 3 in 132 patients; the pathological stage was pT1 or less in 30 patients, pT2 in 51 patients, pT3 in 53 patients and pT4 in 20 patients. Vascular involvement and lymph node metastasis were found in 85 and 33 patients, respectively. The cause-specific 5-year survival rate was 64.2% for all patients, 74.4% for patients with grade 1 or 2 tumors, 62.9% for those with grade 3 tumors; 90.9% for those with stage pT1 or less, 77.9% for those with stage pT2, 45.0% for those with stage pT3 and 29.2% for those with stage pT4 (p < 0.001); 83.2% for patients without vascular involvement and 42.0% for those with vascular invasion (p < 0.001); and 76.5% for patients without lymph node metastasis and 22.7% for those with lymph node metastasis (p < 0.001). Multivariate analysis revealed a strong independent correlation of the pathological stage and lymph node metastasis with poor prognosis and, furthermore, the incidence of lymph node metastasis was significantly related to the increase in pathological stage. CONCLUSIONS: In this series, the pathological stage, lymph node metastasis and vascular involvement, but not tumor grade, were significantly useful prognostic factors in patients who have undergone radical cystectomy for TCC and among them only pathological stage and lymph node metastasis could be used as independent predictors for poor prognosis.
UI - 21180951
AU - Lockyer CR; Gillatt DA
TI - BCG immunotherapy for superficial bladder cancer.
SO - J R Soc Med 2001 Mar;94(3):119-23
AD - Bristol Urological Institute, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK. firstname.lastname@example.org
UI - 21287667
AU - Pietrow PK; Smith JA Jr
TI - Laser treatment for invasive and noninvasive carcinoma of the bladder.
SO - J Endourol 2001 May;15(4):415-8; discussion 425-6
AD - Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2765, USA.
Lasers are widely used in urologic surgery and have many well-developed applications. The use of lasers for the treatment of bladder cancer has been proven to be safe and minimally invasive. The neodymium:YAG laser is the most widely used instrument, although the holmium:YAG laser has also gained recent popularity. Noninvasive, small lesions are especially amenable to management with laser energy and have been treated with success rates that are at least as good as those of standard electrocautery resection. Complication rates are low. Laser therapy of invasive bladder cancer has significant limitations and should probably be restricted to stage T2 lesions.
UI - 21287668
AU - Grob BM; Macchia RJ
TI - Radical transurethral resection in the management of muscle-invasive bladder cancer.
SO - J Endourol 2001 May;15(4):419-23; discussion 425-6
AD - Department of Urology, SUNY Downstate Medical School, Brooklyn, New York 11203-2098, USA.
The morbidity of radical cystectomy and early reports of good results have stimulated interest in radical transurethral resection of bladder tumors (TURBT) for muscle-invasive transitional-cell carcinoma of the bladder. Various investigators have used surgery alone or with adjuvant or neoadjuvant chemotherapy or radiation. Further research is necessary to define the indications, but at present, radical TURBT for muscle-invasive cancer appears to be appropriate for patients too ill to undergo radical cystectomy, those who decline the open operation, and those enrolled in clinical trials of this approach to bladder cancer.
UI - 21296265
AU - Ojea Calvo A; Nunez Lopez A; Alonso Rodrigo A; Rodriguez Iglesias B;
TI - Benavente Delgado J; Barros Rodriguez JM; Nogueira March JL [Value of a second transurethral resection in the assessment and treatment of patients with bladder tumor]
SO - Actas Urol Esp 2001 Mar;25(3):182-6
AD - Servicio de Urologia, Hospital Xeral de Vigo, Vigo, Pontevedra.
OBJECTIVE: To analyse the value of a second transurethral resection, repeated within 3 to 6 weeks after the initial resection, in the treatment and the classification of patients with bladder tumour. MATERIAL AND METHODS: We analyse the results of 72 repeated transurethral resection in 23 (32%) patients with T1 G1-2 bladder tumor, 9 (12.5%) with T1 G3 tumor, 31 (43%) with T2a G2-3 tumor and 9 (12.5%) with T2b G2-3 tumor. The evaluated patients are not associated with CIS. RESULTS: Of all 23 T1 G1-2 tumors, 13 (57%) had residual Ta T1 tumor and 1 (4%) T2 tumor. In this group, the second resection changed the treatment in 1 (4%) patient. Of all 9 T1 G3 tumors, 4 (44%) had residual T1 tumor and 1 (11%) T2 tumor. In this group the second resection changed the treatment in 1 (11%) patient. Of all 31 T2a G2-3 tumors, 5 (16%) had residual T1 tumor, 4 (13%) T2 tumor and 6 (19%) T3-T4 tumor. In this group, the second resection changed the treatment in 10 (32%) patient. Of all 9 T2b G2-3 tumors, 2 (22%) had residual T1 tumor, 1 (11%) T2 tumor and 2 (22%) T3-T4 tumor. In this group, the second resection changed the treatment in 3 (33%) patients. CONCLUSIONS: In T1 G1-2 and T1 G3 tumors, a second transurethral resection detect residual tumor in 36% of patients and change the treatment in 6% of patients. In T2a-b tumors, a second transurethral resection detect residual tumor in 50% of patients and change the treatment in 33% of patients.
UI - 21296266
AU - Paez Borda A; Lujan Galan M; Gomez de Vicente JM; Moreno Santurino A;
TI - Abate F; Berenguer Sanchez A [Preliminary results of the treatment of high grade (T1G3) superficial tumors of the bladder with transurethral resection]
SO - Actas Urol Esp 2001 Mar;25(3):187-92
AD - Servicio de Urologia, Hospital Universitario de Getafe, Madrid.
OBJECTIVE: To examine the results of monotherapy with TUR in the treatment of primary T1G3 transitional cell carcinoma (TCC). METHODOLOGY: Thirty-two patients with primary TCC of the bladder were allocated into a surveillance program. Risk factors for progression to muscle-invasive disease were determined. Immediately, projections of disease-free and progression-free survival were calculated. RESULTS: Five patients (15.6%) were lost in follow-up. Twenty-three (85%) had superficial recurrences. Four patients (14.8%) progressed to muscle-invasive or metastatic disease. No independent risk-factors for progression were disclosed. Median disease-free survival was 8 months. Projection of the risk of recurrence at 79 months was 84.9%. Median time to progression has not been reached yet. Projection of progression at 79 months was 46.3%. CONCLUSIONS: The above mentioned treatment schedule is associated with very high recurrence rates. In addition, recurrences are very frequent. Nevertheless, in the medium run, projections of progression suggest that surveillance can be an alternative to other treatments in the management of T1G3 TCC of the bladder.
UI - 99244784
AU - Denewer A; Kotb S; Hussein O; El-Maadawy M
TI - Laparoscopic assisted cystectomy and lymphadenectomy for bladder cancer: initial experience.
SO - World J Surg 1999 Jun;23(6):608-11
AD - Mansoura Surgical Oncology Unit, Faculty of Medicine, Mansoura University, Ghomhoria Street, PO Box 35516-37, Mansoura, Egypt.
This study discusses our initial experience in the field of laparoscopic management of bladder carcinoma. Ten patients with invasive bladder tumors of variable histology and ranging from stage T2 to T3b were submitted to this procedure. Intraoperative assessment, lateral dissection, posterior dissection, anterior dissection, and urethral transection were achieved laparoscopically. The specimen retrieval and continent pouch construction was performed through a limited abdominal incision. This new regimen allows precise radical lymphadenectomy, early postoperative mobility, fewer wound complications, and shorter hospital stay. The early postoperative results of this procedure are encouraging. Modification and continuous refinement of the technique is still ongoing.
UI - 21468738
AU - Kuznetsov DD; Alsikafi NF; O'Connor RC; Steinberg GD
TI - Intravesical valrubicin in the treatment of carcinoma in situ of the bladder.
SO - Expert Opin Pharmacother 2001 Jun;2(6):1009-13
AD - The University of Chicago, Section of Urology, Department of Surgery, Illinois, USA. email@example.com
The propensity of patients with carcinoma in situ (CIS) of the bladder to progress to invasive and metastatic disease is clearly established. Today, the standard therapy in treating patients with CIS of the bladder is intravesical bacillus Calmette-Guerin (BCG). Nevertheless, patients who fail intravesical BCG have few viable options except to undergo a radical cystectomy. Valrubicin (N-trifluoroacetyladriamycin-14-valerate) is a new semisynthetic derivative of the anthracycline antibiotic doxorubicin that has been shown to benefit patients with BCG-refractory CIS of the bladder. Intravesical instillation of valrubicin is well-tolerated, safe and can be durable. Early non-randomised studies show promise and the current utilisation of this drug is limited to patients with BCG-refractory CIS of the bladder who are not good surgical candidates. Randomised studies of intravesical valrubicin for the treatment of superficial bladder cancer are ongoing.
UI - 21227050
AU - Sakamoto N; Naito S; Kumazawa J; Ariyoshi A; Osada Y; Omoto T; Fujisawa
TI - Y; Morita I; Yamashita H; The Kyushu University Urological Oncology Group Prophylactic intravesical instillation of mitomycin C and cytosine arabinoside for prevention of recurrent bladder tumors following surgery for upper urinary tract tumors: a prospective randomized study.
SO - Int J Urol 2001 May;8(5):212-6
AD - Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan.
BACKGROUND: A recurrence of bladder tumors following surgery for transitional cell carcinoma of the upper urinary tract is not rarely observed. A prospective randomized study was conducted to examine the significance of prophylactic intravesical instillation of mitomycin C (MMC) and cytosine arabinoside (Ara-C) to prevent recurrent bladder tumors after surgery for superficial transitional cell carcinoma of the upper urinary tract. METHODS: The patients were randomized into an instillation group, who received postoperative intravesical instillation of MMC (20 mg) and Ara-C (200 mg) 28 times over a period of 2 years, and a non-instillation group. The non-recurrence rate was then compared between the groups. RESULTS: Of the 27 patients registered, 25 patients (13 with instillation and 12 without instillation) were able to be evaluated, with a median follow-up period of 45 months. The non-recurrence rate of bladder tumors in the instillation group was higher than that in the non-instillation group. Although the difference was not statistically significant, the P-value (P = 0.079) demonstrated a strong trend. When any possible bias was allowed for a multivariate analysis, the difference was almost significant (P = 0.0567). No patients withdrew from this study due to any side-effects. CONCLUSION: The postoperative instillation of MMC and Ara-C may be a useful approach for reducing the recurrence of bladder tumors after surgery for upper urinary tract tumors.
UI - 21283596
AU - Kim JC; Steinberg GD
TI - Medical management of patients with refractory carcinoma in situ of the bladder.
SO - Drugs Aging 2001;18(5):335-44
AD - Department of Surgery, University of Chicago, Pritzker School of Medicine, Illinois, USA.
Bladder cancer is a common genitourinary malignancy and carcinoma in situ (CIS) of the bladder exists as a potentially aggressive variant of the superficial form of the disease. Treatment must reflect the unpredictable nature of this disease entity. In 1976, the use of intravesical Bacillus Calmette-Guerin (BCG) was described for the management of early stage bladder cancer. A subsequent report demonstrated efficacy in a cohort of patients with CIS of the bladder. Since this time, intravesical BCG has been recognised as the initial therapy for CIS of the bladder. Although a 6-week treatment with intravesical BCG has been established as standard therapy in patients with CIS, there has been no consensus as to the subsequent treatment for patients in the setting of failure to initial management with BCG. In addition, a number of reports have demonstrated an increased potential of adverse effects after repeated treatment with intravesical BCG. A variety of alternative immunological and chemotherapeutic agents have been developed in response to the limitations of BCG for patients with refractory CIS of the bladder. At present, valrubicin remains the only agent that is approved by the US Food and Drug Administration for the specific indication of CIS of the bladder unresponsive to intravesical BCG. Although these agents appear promising, the most efficacious therapy remains to be determined. The specific treatment protocol for refractory CIS of the bladder remains elusive. It is ultimately the combined decision of the clinician and patient to determine which course of management is most beneficial.
UI - 21323883
AU - Vaughn DJ; Malkowicz SB
TI - Recent developments in chemotherapy for bladder cancer.
SO - Oncology (Huntingt) 2001 Jun;15(6):763-71, 775; discussion 775-6, 779-80
AD - Department of Medicine Hematology-Oncology Division, University of Pennsylvania School of Medicine, University of Pennsylvania Cancer Center, Philadelphia, Pennsylvania, USA.
Invasive bladder cancer is a chemotherapy-sensitive neoplasm. Historically, the development of cisplatin (Platinol)-based chemotherapy regimens has represented an important advance for patients with metastatic disease. More recently, investigations of new agents, such as gemcitabine (Gemzar) and paclitaxel (Taxol), have resulted in further options for these patients. Randomized trials comparing new regimens with cisplatin-based therapies have been initiated. The role of chemotherapy in the adjuvant and neoadjuvant settings is an area that is undergoing active investigation. The application of prognostic biological markers to risk-stratify patients has resulted in new avenues of investigation in these ongoing early disease trials.
UI - 21523855
AU - Shirakawa T; Sasaki R; Gardner TA; Kao C; Zhang ZJ; Sugimura K; Matsuo
TI - M; Kamidono S; Gotoh A Drug-resistant human bladder-cancer cells are more sensitive to adenovirus-mediated wild-type p53 gene therapy compared to drug-sensitive cells.
SO - Int J Cancer 2001 Oct 15;94(2):282-9
AD - Department of Urology, Kobe University School of Medicine, Kobe, Japan. firstname.lastname@example.org
We investigated the therapeutic potential and molecular mechanism of adenovirus-mediated wt p53 gene therapy for drug-resistant human bladder cancers. KK47, a human bladder-cancer cell line, along with the drug-resistant sublines KK47/DDP10, KK47/DDP20 (cisplatin-resistant) and KK47/ADM (doxorubicin-resistant) were used for the experiments. All 4 KK47 cell lines had genetically normal p53 genes. Using an in vitro cytotoxicity assay, the drug-resistant cell lines were more sensitive to Ad-CMV-p53 cell killing than the KK47 parental cell line. Ad-CMV-p53 induced higher levels of p53 protein and mRNA in the drug-resistant cell lines than in the parental cell line and, consequently, higher levels of p21 and Bax mRNA, which resulted in higher percentages of G(1) cell-cycle arrest and apoptosis. The higher efficiencies of adenoviral gene transfer in the drug-resistant cell lines were confirmed by X-gal staining after infection with Ad-CMV-beta-gal. In conclusion, adenovirus-mediated wt p53 gene therapy was more effective in the drug-resistant bladder-cancer cell lines than in the drug-sensitive bladder-cancer cell line. Copyright 2001 Wiley-Liss, Inc.
UI - 21470098
AU - Morales A; Chin JL; Ramsey EW
TI - Mycobacterial cell wall extract for treatment of carcinoma in situ of the bladder.
SO - J Urol 2001 Nov;166(5):1633-7; discussion 1637-8
AD - Department of Urology, Queen's University, Kingston, Canada.
PURPOSE: Bacillus Calmette-Guerin (BCG) established immunotherapy as an effective modality for carcinoma in situ of the bladder and remains the most effective agent for treatment. However, as a live organism it has the potential for undesirable side effects and toxicity. This result has led to the search for other active and safer biological response modifiers. We investigated the efficacy of a mycobacterial cell wall extract (MCWE) from Mycobacterium phlei, which does not contain live bacteria, for management of carcinoma in situ of the bladder in humans. MATERIALS AND METHODS: The requirement for an emulsified preparation was investigated with photon correlation spectroscopy to determine the stability of the bacterial fragments. A total of 61 patients with histologically documented carcinoma in situ completed the study. Cell wall extract from M. phlei suspended in oil droplets to form an emulsion were instilled into the bladder at a dose of 4 mg. once weekly for 6 weeks and then monthly for 1 year. Response assessment was performed at 3-month intervals. Complete response to treatment indicated the absence of endoscopic and histological evidence of carcinoma in situ. Partial responders were those cases in which cystoscopy and biopsies were negative but cytology was suspicious for malignant cells. All other cases were considered failures. RESULTS: The need for an emulsified suspension of the cell wall extract was confirmed by the demonstration that the cell wall extract alone in urine aggregated, whereas the MCWE emulsion had remained stable. Kaplan-Meier estimates showed negative cystoscopy and biopsies in 62.5% at 12, 49.3% at 24 and 41.1% of patients at 60 weeks after therapy. After this point the number of responders had remained stable. Excellent tolerance with minimal toxicity was observed. CONCLUSIONS: Our study demonstrates clinical activity of low doses of MCWE against human bladder cancer. The results observed at the dosage used in our trial are less than those observed with live BCG. However, MCWE has a better toxicity profile and can be instilled in the presence of a disrupted urothelium. It also appears to exhibit activity in patients in whom BCG has failed.
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